Pay Back

Harvey Silverman

"I'm very worried about your mother."

Oh, Jeez. My silent reaction was something between a sigh and a moan. Sadness combined with annoyance. My poor dad.

Watching him slowly deteriorate was distressing and painful. Gradually at first, barely noticeable, simply a part of growing old; no, the physical frailty was obvious now and sad enough but it was his mental state that was most upsetting. He had been such a smart man, bright, determined, stalwart, dependable, mentally and emotionally strong. Now his random episodes of confusion and forgetfulness were more frequent and his fears and anxieties increased. He had become reluctant to travel, afraid of how he might feel or what might happen, preferring to remain within the presumed security of his own home. He worried about everything, his health, my mom's health, the tree next to the house that he imagined might fall onto the roof, what time the mail would arrive.

Of course I was the one he would call. The older child who was a physician and thereby invested with the knowledge and wisdom that many, at least of his generation, faithfully believed resided within the being of the medical practitioner. Their son the doctor of whom my folks were so proud.

It had not been easy, but they had somehow found a way to provide for the greater part of the cost of my medical education. My dad had once aspired to practice medicine; he determined that the financial burden on his parents would be too great. Instead he became a pharmacist, and while his folks had earned a living selling penny candies, two cent seltzers and two-for-a-nickel cigars, he did a bit better, but the cost of my education had risen far faster than he and my mom had been able to save. Still, they found a way.

I spent the first fifteen years of practice as an emergency physician. A type of practice that was fast paced, exciting, stressful, and rewarding. Patients were seen, diagnosed, treated, admitted to the hospital or discharged. Then it was off to the next patient.

My folks were proud when I became board certified in emergency medicine, though they may not have entirely understood what that meant; they were proud when I contributed a chapter to an emergency medicine textbook, proud when I became director of an emergency department.

Now, though, I was in a general practice in an office with a sign out front that displayed my name, which meant that I was a physician in the way they had imagined and in the form with which they had grown up. Sometimes during visits they would detour to drive past the office simply to see my name on the sign. Patients were seen in a slower, calmer, more leisurely fashion and then seen again. Patients' worries, concerns, fears were discussed in greater detail. I enjoyed listening and when appropriate, reassuring.

So of course my dad had called me. Again.

He had already called me that day, earlier in the afternoon. My mom had abdominal pain, he told me during that first call, and they had gone to see their doctor who had told them she was all right for now and sent them home. My dad thought that she was more ill than the doctor had recognized. He thought more needed to be done. He worried.

I had asked to speak with my mom and our conversation was brief and her comment not unexpected.

"I'm okay."

I told my dad I'd call the doctor and speak with him and ask just what he had found when he had seen her. As a physician myself I would be able to get details that might be helpful so far as reassuring my folks, particularly my dad who needed, clearly, to be reassured.

I had spoken with their physician a handful of times in the past few years regarding one or the other of my folks. I thought him, based upon those conversations, to be reasonably competent. I would have done some things differently than he but medicine is that way; there is often more than one way to do things. Now I called and he told me that he had seen and examined my mom that day, she had some abdominal pain that did not appear to be severe or immediately worrisome, he had ordered some tests to be done the following week to look further.

I called my dad back to tell him I had spoken with their doctor and confirmed what they had been told. If my mom were not a lot better by morning he should call the doctor and arrange for her to be re-evaluated. My dad did not seem completely happy with this advice but agreed to it.

I returned to my own patients, worried more about my dad and his anxiety than about my mom, whose condition sounded to be under control for the moment.

About an hour later our secretary told me I had a phone call.

"It's your dad again."

"I'm very worried about your mother."

The poor guy, I thought. It had been breaking my heart to watch what was happening to him these past years, powerless despite my years of training and experience to fix it. The best I had been able to do beyond seeing that he received the best care available was to listen, to care, to love. I told him that when I finished my work in the office I would drive to their home and see for myself. In the background I heard my mother yelling at my dad.

"No. I don't want him to come."

Just like my mom, I thought. But I had to go. Not so much for my mom, who would be okay for now according to the doctor who had actually seen her and laid on hands, but for my dad. He was clearly in bad shape mentally and I needed to be there to comfort him. I would drive down, check out my mom, stay for a bit and visit, and then I would drive the hour and a half back home with my dad's mind hopefully set to rest.

As I drove to their home I thought about the irony, the reversal of roles for my dad and me. Was this inevitable, would I someday have to rely on my sons to provide to me the strength and reassurance my dad now required?

I arrived and walked in the door, left open. In seconds, from across the room, I saw my mom was severely ill. In a few seconds more I knew she had a septic gall bladder. She was far too ill for me to get her to my car so I called 911.

Minutes later she was on her way to the hospital. I got my dad into my car and we were off to the ER and my mom. I sat my dad down in the waiting room and after a few minutes I was speaking with the emergency physician, giving him my mom's history, medication list, and recounting the events of the day. I then left him to do his job.

A half hour later my dad and I were next to my mom, IV running, antibiotics infusing, oxygen flowing, pain medication working. My dad kissed her tenderly and she smiled at him.

"Okay, go home now," she said.

I stayed the night with my dad.

My mom recovered, went home and lived another decade, lovingly caring for my dad as he continued his descent into dementia. He had saved her life with his calls to me. There is no doubt that had they waited until the next day she would have died.

Driving home I could not help but reflect upon how I had come to be a physician and thus contribute to my mom's survival. My folks had somehow produced the funds necessary. They did not have the resources yet managed nevertheless.

In some cosmic ledger the account had come closer to being in balance. But how? I had made the correct diagnosis; the education my folks provided made that possible. Yet it was mom's illness and my dad's concern that allowed me to enjoy a sense of happy and comfortable satisfaction that I had been able to use to their benefit what they had made possible -- which was to my benefit as well.

Cosmic ledgers can be tricky, I decided. Perhaps it was in balance all the time.